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Tsilika M, Thoma G, Aidoni Z, Tsaousi G, Fotiadis K, Stavrou G, Malliou P, Chorti A, Massa H, Antypa E, Vasiliadou G, Pagdatoglou K, Voudouris A, Vasiliagou S, Mitos G, Kontopoulou N, Paraforou N, Antoniadou E, Mouloudi H, Gkeka E, Grosomanidis V, Giamarellos-Bourboulis EJ, Kotzampassi K. A FOUR PROBIOTIC PREPARATION FOR VENTILATOR-ASSOCIATED PNEUMONIA IN MULTI-TRAUMA PATIENTS: RESULTS OF A RANDOMIZED CLINICAL TRIAL. Int J Antimicrob Agents 2021; 59:106471. [PMID: 34757134 DOI: 10.1016/j.ijantimicag.2021.106471] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 10/17/2021] [Accepted: 10/24/2021] [Indexed: 12/31/2022]
Abstract
The role of probiotics for the prevention of ventilator-associated pneumonia remains inconclusive. Our aim was to assess the efficacy of a probiotics regimen for VAP prophylaxis in mechanically ventilated multi-trauma patients, intubated immediately after the injurious insult. In a randomized, placebo-controlled study enrolling multi-trauma patients, anticipated to require mechanical ventilation for more than 10 days were randomly assigned to receive prophylaxis either with a probiotic formula [n=59] or placebo [n=53]. The probiotic formula was a preparation of Lactobacillus acidophilus LA-5 (1.75 × 109 cfu), L. plantarum (0.5 × 109 cfu), B. lactis BB-12 (1.75 × 109 cfu) and S. boulardii (1.5 × 109 cfu) per sachet. Each patient received two sachets twice daily for 15 days; one through the nasogastric tube; and another spread on the oropharynx. The incidence of VAP was the primary endpoint. The incidence of other infections and sepsis and the duration of hospital stay were the secondary endpoints. Probiotics administration reduced notably the incidence of VAP [11.9% vs 28.3%, odds ratio 0.34, 95%CIs 0.13-0.92, p=0.034] and of sepsis [6.8% vs 24.5%, OR 0.22, 95% CIs 0.07-0.74, p=0.016]. Furthermore, probiotics prophylaxis decreases the time of stay in the intensive care unit (ICU) and of hospital stay. The prophylactic use of probiotics as a combination of enteral and topical application to oropharynx exerted a positive effect on the incidence of VAP and sepsis as well as on the ICU and total hospital stay in patients under protracted mechanical ventilation.
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Affiliation(s)
- Maria Tsilika
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Giannoula Thoma
- Intensive Care Unit, AHEPA General Hospital, Thessaloniki, Greece
| | - Zoi Aidoni
- Intensive Care Unit, AHEPA General Hospital, Thessaloniki, Greece
| | - Georgia Tsaousi
- Intensive Care Unit, AHEPA General Hospital, Thessaloniki, Greece
| | | | - George Stavrou
- Department of Surgery, Aristotle University of Thessaloniki, Greece
| | - Petra Malliou
- Department of Surgery, Aristotle University of Thessaloniki, Greece
| | - Angeliki Chorti
- Department of Surgery, Aristotle University of Thessaloniki, Greece
| | - Helen Massa
- Intensive Care Unit, Ippokrateion General Hospital, Thessaloniki, Greece
| | - Elli Antypa
- Intensive Care Unit, Georgios Gennimatas General Hospital, Thessaloniki, Greece
| | - Georgia Vasiliadou
- Intensive Care Unit, George Papanikolaou General Hospital, Thessaloniki, Greece
| | | | - Antonios Voudouris
- Intensive Care Unit, Aghios Pavlos General Hospital, Thessaloniki, Greece
| | | | - Giakoumis Mitos
- Intensive Care Unit, AHEPA General Hospital, Thessaloniki, Greece
| | - Ntina Kontopoulou
- Intensive Care Unit, Georgios Gennimatas General Hospital, Thessaloniki, Greece
| | - Niki Paraforou
- Intensive Care Unit, Trikala General Hospital, Trikala, Greece
| | - Eleni Antoniadou
- Intensive Care Unit, Georgios Gennimatas General Hospital, Thessaloniki, Greece
| | - Helen Mouloudi
- Intensive Care Unit, Ippokrateion General Hospital, Thessaloniki, Greece
| | - Eleni Gkeka
- Intensive Care Unit, AHEPA General Hospital, Thessaloniki, Greece
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